Der Vergleich von verschiedenen dorsalen Stabilisierungstechniken im Bereich der Brustwirbelsäule unter Betrachtung der Stabilität - eine biomechanische Studie
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Philipps-Universität Marburg
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Abstract
The vertebral compression fracture has developed into a socio-economic
disease, because of its increasing incidence in the last few years. Particularly
young people can be endangered to suffer a traumatic A3- or A4-fracture (AO
spine injury classification) through high-speed trauma in traffic and falls.
For years there has been a debate about the various surgical treatment options
for these so-called burst fractures.
In addition to ventral instrumentation and combined surgery, dorsal surgical
treatment is just one of the many different treatment procedures that can be used
to stabilize a thoracic vertebral fracture. While many studies have examined the
comparison between dorsal, ventral and combined procedures, there is still no
recommendation which dorsal instrumentation procedure guarantees the best
treatment.
It is not clarified yet whether it is necessary to stiffen four spinal column segments
or whether a bisegmental instrumentation (possibly including cement
augmentation) is sufficient for adequate stabilization. The resulting question for
this study was: Which dorsal stabilization method shows the greatest stability in
case of a thoracic vertebral fracture and prevents most effectively a loss of height
of the broken vertebral body after surgical treatment?
In the context of this question, the obvious hypothesis that a stiffening over four
segments ensures greater stability than a stiffening over two segments (with or
without cement augmentation) had to be investigated and discussed.
To answer the question and to improve the treatment of burst fractures the
following was done.
15 fresh-frozen human cadaveric spines were prepared used and embedded in
Technovit. A standardized burst fracture (A3 / A4 according to AO classification)
was generated at the level of the vertebral body Th5 by a free-falling weight.
The fractures were treated with one of three dorsal osteosynthesis methods.
Pedicle screw systems over two segments with and without cement and pedicle
screw systems over four segments were used.
After the instrumentation the spines was loaded with a servohydraulic machine.
Forces and frequency of the load were similar to the physiological load in the first
six weeks after the operation.
The stability of the spine was measured by the compressibility of the spine and
the loss of height of the vertebral body Th5. At different times the anterior, central
and posterior heights of the index vertebra were measured.
The study provides the following results.
Compared to the other instrumentation methods, the dorsal stiffening over four
segments allows less compression. Furthermore, with multi-segment stiffening,
the central height does not decrease to the level of the fracture after loading.
Both results do not seem to be influencing factors for the loss of height of vertebral
Th5 after load. All procedures show a significant loss of height.
There is no advantage of one dorsal procedure over the others.
The low number of cases, the properties of the spines and the test possibilities
were limited, which allows only partially transferable results to the in vivo
situation.
Further biomechanical and clinical studies must be conducted to make a final
decision, which dorsal surgical procedure allows the best clinical treatment for
burst fractures.
The questions raised in this study, whether a more complex multisegmental or
cementaugmented dorsal stabilization is necessary at all, if there is a burst
fracture with only little loss of height, could be the next point that needs to be
studied.
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Created: 2023Issued: 2023-05-02Updated: 2023-05-02
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Multi-Segmental RestorationBrustwirbelsäuleLoadingCement AugmeBi-Segmental RestorationCompression FractureThoracic SpineBiomechanicsDorsal Stabilization
DFG-subjects
WirbelsäuleBisegmentalDorsale StabilisierungBiomechanikBelastungZementaugmentationKompressionsfrakturMehrsegmentalBrustwirbelkörper
DDC-Numbers
610
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Lintker, Nils: Der Vergleich von verschiedenen dorsalen Stabilisierungstechniken im Bereich der Brustwirbelsäule unter Betrachtung der Stabilität - eine biomechanische Studie. : Philipps-Universität Marburg 2023-05-02. DOI: https://doi.org/10.17192/z2023.0339.